Cattedra di Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Viale del Policlinico 155, 00161 Rome, Italy.
J Rheumatol. 2012 Jan;39(1):41-5. doi: 10.3899/jrheum.110158. Epub 2011 Nov 1.
Tumor necrosis factor-α (TNF-α) antagonists bring about significant improvement in chronic inflammatory diseases such as rheumatoid arthritis (RA) and spondyloarthritis (SpA). There is some evidence that they can also have negative myocardial effects, but to date this issue has not been clarified. We evaluated changes in electrocardiographic measures [QT interval, corrected, dispersion, and dispersion corrected (QT, QTc, QTd, QTdc, respectively)] in patients with RA or SpA treated with anti-TNF agents (infliximab and etanercept), those treated with other biological agents (rituximab), and with methotrexate.
We studied 38 consecutive patients with RA (21 patients) or SpA (19 patients) being treated with TNF-α antagonists, 8 patients with RA being treated with rituximab, and 13 patients (8 with RA and 5 with SpA) taking methotrexate. Electrocardiographs (ECG) were performed on all participants at baseline and 12 months after initiation of treatment, and the QT, QTc, and QTd were calculated with standard procedures.
After 12 months of treatment, significant increases over baseline values were observed in the mean QT (p < 0.009), QTd (p < 0.0001), and QTdc (p < 0.0001) of the anti-TNF group, but no significant changes were observed in those taking rituximab. QT changes in the anti-TNF group were unrelated to the disease (RA vs SpA) or drug (infliximab vs etanercept), and none were associated with clinical manifestations of cardiac disease.
In patients with RA and SpA, TNF-α antagonists seem to increase the QT and QTd measures. Although these changes were completely asymptomatic, ECG may be indicated in patients being considered for anti-TNF therapy to identify those at risk for cardiac complications.
肿瘤坏死因子-α（TNF-α）拮抗剂可显著改善类风湿关节炎（RA）和脊柱关节炎（SpA）等慢性炎症性疾病。有一些证据表明，它们也可能对心肌产生负面影响，但迄今为止，这个问题尚未得到澄清。我们评估了接受抗 TNF 治疗的 RA 或 SpA 患者（英夫利昔单抗和依那西普）、接受其他生物制剂（利妥昔单抗）和甲氨蝶呤治疗的患者心电图测量值[QT 间期、校正、离散度和校正离散度（QT、QTc、QTd、QTdc）]的变化。
我们研究了 38 例连续接受 TNF-α拮抗剂治疗的 RA（21 例）或 SpA（19 例）患者、8 例接受利妥昔单抗治疗的 RA 患者和 13 例（8 例 RA 和 5 例 SpA）接受甲氨蝶呤治疗的患者。所有患者在基线和治疗开始后 12 个月时进行心电图（ECG）检查，并采用标准程序计算 QT、QTc 和 QTd。
在接受治疗 12 个月后，抗 TNF 组的平均 QT（p<0.009）、QTd（p<0.0001）和 QTdc（p<0.0001）值与基线相比显著增加，但接受利妥昔单抗治疗的患者则没有明显变化。抗 TNF 组的 QT 变化与疾病（RA 与 SpA）或药物（英夫利昔单抗与依那西普）无关，且与心脏病临床表现无关。
在 RA 和 SpA 患者中，TNF-α 拮抗剂似乎会增加 QT 和 QTd 测量值。尽管这些变化完全无症状，但对于考虑接受抗 TNF 治疗的患者，可能需要进行心电图检查以识别有心脏并发症风险的患者。
